Chronic Pulmonary Infection Flashcards
What's the diff. diagnosis of: Shadow on CXR Weight loss Persistent sputum production Chest pain Increasing SOB
Lung Cancer Intrapulmonary abscess Empyema Bronchiectasis CF
What are the risk factors for developing chronic pulmonary infection?
Abnormal host response- immunodeficiency/ immunosuppression
Abnormal innate host defence- Damaged bronchial mucosa/ abnormal cillia/ abnormal secreation
Repeated insult- aspiration/ indwelling material (eg NG or ET tube)
What immunoglobulin deficiencies are associated with chronic pulmonary infection?
IgA deficiency- more accute
Hypogammaglobulinaemia
CVID- common cause, recurrent infections
Specific Polysaccharide Antibody Deficiency
What are other causes of immunodeficiency?
Hypo-splenism
Immune paresis- myeloma, lymphoma, metastatic malignancy
HIV
What are some common causes of immunosuppression?
Steroids Azathioprine METHOTREXATE Cyclophosphamide Monoclonal antibodies (Infliximab, etanercept, TNFa/ rituximab/ leflunamide) Chemo
What causes defective innate host defence?
Damaged bronchial mucosa Abnormal cillia ( Kartenager's syndrome, Young's syndrome Abnormal secretions (CF, channelopathies)
What causes repeated insult?
Recurrent aspiration (NG feeding, poor swallow, pharyngeal pouch) Indwelling material (NG tube, chest drain, inhaled foreign body?
What’s an intrapulmonary abscess?
Indolent presentation (quietly growing) Weight loss Lethargy, tiredness, weakness Cough sometimes sputum high mortality if untreated usually a preceding illness of some sort (pneumonic, post viral, foreign body)
what bacteria is very good at causing abscesses?
Staph Pneumonia
What can cause aspiration pneumonia?
Vomiting
Lowered conscious level
Pharyngeal pouch
what poor immune response is associated with pulmonary abscess?
hypogammaglobulinaemia
What pathogens are common of lung abscess?
Streptococci Staphylococci E-coli Gram negatives fungi- aspergillus
What are three main causes of septic emboli?
Right sided endocarditis
Infected DVT
Septicaemia
How does IV drug use lead to septic emboli?
Inject into groin,
DVT
Infection
PE + abscesses
What is empyema?
Pus in pleural space- infected pleural effusion
What is pleural effusion?
fluid in pleural space
what does empyema look like on a CT scan?
C- shaped
like a banana
What are signs of simple parapneumonic effusion?
Clear fluid
pH > 7.2
LDH < 1000
Glucose > 2.2
what are signs of complicated parapneumonic effusion/
pH < 7.2
LDH >1000
Glucose < 2.2
NEEDS CHEST TUBE DRAINING
what are signs of empyema?
frank pus
How would you diagnose empyema?
Clinical suspiscion
CXR
USS
CT
What does a D shape on CXR indicate?
Empyema
Empyema treatments other than chest drain?
IV antibiotics
- broad spectrum
- amoxicillin and metronidazole initially
Oral antibiotics
How should you tap an empyema?
with a USS
What is bronchiectasis?
Localises, irreversible dilation of bronchial tree
What is the presentation of bronchiectasis?
Recurrent "chest infections" Recurrent antibiotic prescriptions No response to antibiotics Short lived response to antibiotics Persistent sputum production
How to diagnose bronchiectasis?
Cough productive of sputum
chest pain
recurrent LRTIs
Radiological- HRCT
What would be characteristic on a brochiectasis CT?
Cygnet rings
What causes bronchiectasis?
Bronchial obstruction CF Young's and Kartanager's syndrome ABPA Immunodeficiency Rheumatoid arthritis bronchopulmonary sequestration Monier-Khum syndrom (lack of tracheal cartillage) Yellow Nail syndrome ABOUT 50% IDIOPATHIC
What is chronic bronchial sepsis?
hallmarks of bronchiectasis but no radiological signs
Who are likely to get chronic bronchial sepsis?
Young women working with children
Older people with COPD or airways disease
How to treat chronic bronchial sepsis?
Stop smoking
Flu vaccine
reactive antibiotics: sputum sample, antibiotics appropriate to most recent positive culture
What are some anti-inflammatory treatments for bronchiectasis?
clarithromycin 250mg OD
Azithromycin 250mg three times a week
